Jennifer Rowland, Ph.D.

During a recent presentation to a group of colleagues in the public health field, I used the term 'secondary conditions' to report on results from a set of focus groups of older adults, ages 65-90 yrs, who were discussing health problems they have encountered as a result of the aging process. There were a few puzzling looks in the audience until the question was asked: 'If you are saying that these older adults are reporting secondary conditions, what is their primary condition?' This is a fundamental question to filtering out what are natural or typical conditions (http://www.dictionary.com defines condition as a particular mode of being of a person or thing; existing state; situation with respect to circumstances) of aging versus what are conditions that can be 'prevented' or 'mitigated' through health promotion efforts. It also raises an important question in the debate concerning the definition of secondary conditions. Although many of the people who had participated in my focus groups had primary health conditions (i.e., arthritis, cardiovascular disease), the primary focus of the study was to determine how the aging process (which I had referred to as the 'condition') was impacting their ability to fully participate in society and live independent and productive lives. Data from the 2004 National Health Interview Survey indicate 34% of adults ages 65 and older report having a disability, and other national surveys (SIPP and Census) report up to 52% of the population ages 65 and older have a disability that indicates they 'need help' in daily living.

The term 'secondary conditions' is a term used by several federal funding agencies including the National Institute on Disability and Rehabilitation Research (NIDRR) and the Centers for Disease Control (CDC), as well as in the recent report, The Future of Disability in America published by the Institute of Medicine (IOM), to refer to medical and psychosocial consequences that have causal relationships to a primary disabling condition and are preventable and influenced to some extent by personal (i.e., behavior, age) and environmental (i.e., assistive technology, built environment) factors. As has been discussed previously in this column, there is also some debate about the broader use of the term secondary conditions to reflect such conditions as social isolation, difficulty forming relationships, and high levels of unemployment.

Despite the differences in definitions and how they may be used in the context of disability or to separate the natural aging process from other processes, what is clear is that secondary conditions have an enormous impact on a person's health, function and quality of life. In the recently published report by the IOM, secondary conditions were recognized as a major limiting factor in the promotion of good health, independence, and social integration. This term can apply to people that are aging (i.e., depression, fatigue, loneliness, incontinence, etc.) or people with a specific disability. The key element is that the condition is preventable and by knowing that it exists, there can be clearer and more focused health promotion strategies. Although not defined in the same terms, solutions to inaccessibility of important physical and psychological health promotion services may have common solutions. A recently aired news program (CBS Evening News) discussed the use of assistive technology in a chain of grocery stores in Germany to improve accessibility of their facilities for older adults. These stores are attaching magnifying glasses to the shopping carts and providing pull-out seating on the carts to allow customers to sit and read product labels that have been traditionally difficult to read because of small print. Although these accommodations were originally intended to assist older consumers, it is clear that this type of technology could also potentially help people with disabilities. Whether they are called secondary conditions or complications/impairments resulting from the aging process, it is clear that the answer to accessible communities for all people will lie in universal design of structures, programs, and staff training that can allow them to fully participate in all aspects of society.

For other NCHPAD documents and publications regarding universal design and accessibility please go to:

• This month's Director's column, 'Inaccessibility of the Built Environment Hits Home' at http://www.ncpad.org/476/2363/2007-7~Issue~~Inaccessibility~of~the~Built~Environment~
  Hits~Home
  
• Rauworth, A.E. (2006). 'Designing a Fitness Facility for All' in the Disability Awareness Edition of the American College of Sports Medicine's Certified News, Vol. 16, Issue 4 found at http://www.acsm.org/AM/Template.cfm?Section=ACSM_s_Certified_News
  
• Look for an article coming soon in the 2007 Developer's Guide (in press) of the Journal for Active Aging (http://www.icaa.cc/publications.htm) in which Amy Rauworth and Blythe Hiss, both of NCPAD, discuss how to create an accessible fitness or wellness facility.

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I encourage you to write to me with suggestions for future column topics or to comment on the information provided in this column. You can reach me by e-mail at jenrow@uic.edu.